[Application and experience of 5G-based telesurgery in robotic radical gastrectomy]

Objective: To evaluate the safety and feasibility of applying 5G remote technology in robotic radical gastrectomy. Methods: The surgery employed the domestic Tumai Endoscopic Surgical Robot System (MT-1000; Shanghai MicroPort Medical Robot Co., Ltd., Shanghai, China) and the domestic Jingfeng Multi-port Laparoscopic Robot (MP1000; Shenzhen Jingfeng Medical Technology Co., Ltd., Shenzhen, China). Each robot system consists of three main components: a patient surgical platform, an imaging platform, and a surgeon console. A 5G Customer Premise Equipment (CPE) was used to connect the lead surgeon remotely with the on-site patient via the public 5G wireless network (China Mobile, Beijing, China). Specialized monitoring software based on the User Datagram Protocol (UDP) was utilized to continuously and real-time monitor network latency and packet loss during each operation. This software provided continuous visualization and recording of key network indicators, including total latency, round-trip network latency, and packet loss rate. Network latency monitoring was conducted in real-time at 2-ms intervals: the local terminal sent its current system timestamp to the remote terminal every 2 ms, and the remote terminal immediately returned the timestamp unchanged upon receiving the data. To ensure uninterrupted data transmission when necessary, the system was equipped with a dedicated network transmission line as a backup option. In addition, an extra backup surgical console was configured at the local surgical site, enabling immediate takeover of control for hot backup when required. A second qualified robotic surgeon was always present on-site to directly supervise the surgical system. The local surgical team assumed the highest safety responsibility, held the highest authority over the robot system, and could immediately activate the emergency stop function for intervention in case of system abnormalities. Meanwhile, the local team was responsible for approving remote control requests and had the right to decide whether to accept such requests. In the event of network anomalies, the system control could be seamlessly switched to the local main control terminal within a few seconds. Results: From September 2023 to March 2025, a total of 37 cases of 5G remote robotic radical gastrectomy were performed between the two campuses of the Fourth Hospital of Hebei Medical University, as well as between this hospital and Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Handan First Hospital, and Huanghua People's Hospital. Among the patients, there were 25 males and 12 females, with an average age of 64 years. Regarding the distribution of the main operation terminal and the patient terminal: for 30 surgeries, the main operation terminal was located at the East Campus, and the patient terminal was at the Main Campus; for the remaining 7 surgeries, the main operation terminal was at the Main Campus, while the patient terminals were at Ruijin Hospital Affiliated to Shanghai Jiao Tong University (5 cases), Handan First Hospital (1 case), and Huanghua People's Hospital (1 case). All 37 surgeries were successfully completed, including 13 cases of total gastrectomy and 24 cases of distal gastrectomy. The operation time was (204.5±43.8) minutes, the intraoperative blood loss was (52.4±19.1) ml, and no serious postoperative complications occurred. The number of lymph nodes dissected was (36.2±12.2). The median times for the first postoperative flatus, oral feeding, and liquid diet intake were 2, 2, and 4 days, respectively, and the median postoperative hospital stay was 8 days. The 5G network exhibited good stability, with a total latency of (219.1±20.0) ms, a round-trip latency of (33.5±9.4) ms, and a packet loss rate of <0.1%. Conclusion: Remote robotic radical gastrectomy based on 5G communication technology is safe and feasible when implemented across hospitals of different tiers, and it is worthy of further promotion.